Predictive factors for hospitalization in patients on integrated home care program

This study aims to identify factors associated with hospitalization in patients undergoing an Integrated Home Care (IHC) program.

Retrospective observational study.

We collected personal, clinical/logistic data and characteristics of the care delivered about the patients from the Ferrara province (Emilia Romagna, Italy) for whom, in 2018, has been introduced an IHC. We extracted all traceable emergency room (ER) evaluations and hospitalization in the year 2018 for each IHC case. Hospitalization has been considered as a IHC failure. The study primary outcome has been evaluation of factors (individual, familiar, and organizational) associated with hospitalization. As a secondary analysis we evaluated the frequency of ER admittance and recovery according to the days of the week and the time of the day. Descriptive data analysis and comparison of demographic, social, clinical, and organizational characteristics between patients hospitalized versus patients who have not been hospitalized have been made. To evaluate the causes related to risk for hospitalization we applied multivariate longitudinal data analysis for recurring events.

At multivariate analysis just age [Hazard Ratio (HR):1.014/year, 95% confidence interval (95%CI):1.005-1.023], sex [HR:0.735 (female), 95%CI:0.636-0.850], parenteral nutrition [HR:1.752, 95%CI:1.105-2.778], pressure sores [HR:1.249, 95%CI:1.042-1.498] and advanced palliative care for oncologic [HR:1.719, 95%CI:1.174-2.517] and non-oncologic conditions [HR:4.530, 95%CI:3.110-6.600] remained significantly associated with hospitalization risk. In the year of observation 1512 hospitalizations occurred showing threefold more frequent access to the ER for hospitalization during the day (74.74% during daytime, 25.26% at nighttime). We observed an almost regular distribution of ER admittances from Monday to Saturday, and a nadir on Sunday.

It seems that specific conditions of patients on IHC impact the most in terms of hospitalization risk. This evidence could be a drive to deflect resources for better framing of these conditions and improving their management at home.